Category: Home Health Reimbursement
2019 Rural Add-On Changes
By Melinda Gaboury / Posted on: November 30, 2018 3 minutes to readAs if the changes in the payment system were not enough. Based on the 2019 Medicare Home Health Final Rule, released in early November 2018, the Rural Add-On is being completely revised.
VIEW POST2019 Value Based Purchasing Proposed Changes
By Melinda Gaboury / Posted on: August 27, 2018 5 minutes to readCMS released the CY2019 Medicare Home Health payment rule July 12, 2018. A large part of the proposed changes are to the Value-Based Purchasing (VBP) Model. One of the agency’s proposed refinements of VBP is removing five measures while adding two new proposed composite measures.
VIEW POST2019 Home Health Proposed Payment Rule – PDGM 2020
By Melinda Gaboury / Posted on: August 8, 2018 9 minutes to readThe Centers for Medicare and Medicaid Service (CMS) released the CY2019 Medicare Home Health payment rule July 12, 2018. This proposed rule is voluminous and carries an immense number of proposed changes. HPS will continue analyzing and updating the proposed elements of this rule.
VIEW POSTPre-Claim Review Demonstration Coming Back?
By Melinda Gaboury / Posted on: June 7, 2018 4 minutes to readCMS released a Comment Request, via the Federal Register, regarding Pre-Claim Review Demonstration being set to return on or after October 2018 in Illinois, Ohio, North Carolina, Florida, and Texas. The revised demonstration would last five years and Illinois will kick off the demonstration again and will be followed by Ohio and North Carolina and later Texas and Florida.
VIEW POSTTargeted Probe and Educate – What We Have Learned So Far
By Melinda Gaboury / Posted on: March 13, 2018 7 minutes to readTargeted Probe & Educate began on 10/1/17 and is full speed ahead. HPS has discovered nuances with TPE that we did not expect nor have we experienced in past ADR reviews. This review includes targeted medical review and education along with the potential of elevated action toward the agency. This elevated action could take place if the agency is not meeting the standards laid out by the Medicare MAC.
VIEW POSTHome Health & Hospice PEPPER Reports
By Melinda Gaboury / Posted on: January 15, 2018 7 minutes to readOver the past couple of years, HPS has reported and discussed that Home Health and Hospice PEPPER Reports are very important and should be reviewed by all agencies. We have also been open about the number of agencies in the country that have never opened the reports. HPS is happy to report that, for the 8 months ending December 20, 2017, 58.5% of all hospices have opened their reports. Only 5 states and 1 territory are below 50%. The sad news is that home care…
VIEW POSTNew Medicare Beneficiary Identifiers
By Melinda Gaboury / Posted on: December 20, 2017 4 minutes to readHPS has given you a couple of updates on the new Medicare Beneficiary Identifier (MBI) cards over the past few months and we continue that update today. Following are more questions answered about the new Medicare numbers and how that will affect your agency. Key dates to remember: April 1, 2018 – Patients will begin to receive new Medicare cards and agencies should begin the process of asking…
VIEW POST2018 Home Health Final Rule
By Melinda Gaboury / Posted on: November 14, 2017 8 minutes to readThe Breaking News that has every one full of excitement and hope is that the 2018 Home Health Final Rule does NOT include finalizing HHGM, at this time, which was set for implementation in 2019! The battle has been won, BUT the war has just begun! Some form of payment reform will occur in home health. It is not…
VIEW POSTClaim Denials Due to NO OASIS Will Now Return to Provider
By Melinda Gaboury / Posted on: October 23, 2017 6 minutes to readThe claim edit that has been in place since April 3, 2017 has been denying home health claims, at the point of billing, if the matching OASIS was not in the ASAP database. Some of these denials have been the result of data not matching between the claim and the OASIS, primarily the patient’s HIC number being different or the OASIS…
VIEW POSTNew Medicare Cards – Questions Answered
By Melinda Gaboury / Posted on: October 10, 2017 6 minutes to readHPS reported on the coming changes to the Medicare cards a few months ago. Today we offer more answers as have been gathered from CMS via the Medicare Learning Network page of the CMS site. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires the removal…
VIEW POSTTargeted Probe and Educate
By Melinda Gaboury / Posted on: September 25, 2017 5 minutes to readHPS reported recently regarding continued Probe & Educate for Home Health agencies. This is to clarify that the CMS expansion on Probe & Educate is for Home Health and Hospice and will be effective 10/1/2017. This is referred to as Targeted Probe & Educate (TPE). This review will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc.
VIEW POST2018 Home Health Proposed Payment Rule – Including Intro to HHGM
By Melinda Gaboury / Posted on: July 31, 2017 13–15 minutes to readThe Centers for Medicare and Medicaid Service (CMS) released the CY2018 Medicare Home Health payment rule last week. This proposed rule is voluminous and carries an immense number of proposed changes. HPS will continue analyzing and updating on the proposed elements of this rule.
VIEW POSTDelayed Implementation of Home Health CoPs
By Melinda Gaboury / Posted on: July 14, 2017 2 minutes to readLast week CMS issued a Final Rule that changed the new Home Health CoPs rule implementation date to January 13, 2018. HPS announced the proposed rule a few months ago. NAHC and the Forum of State Associations spearheaded this effort to postpone the rule because of the extensive changes that are…
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Changes Coming to Medicare HIC Numbers – Medicare Beneficiary Identifier
By Aaron Carey / Posted on: June 22, 2017 5 minutes to readFormer President Harry S. Truman was the very first Medicare beneficiary to be issued a Health Insurance Claim Number (HICN) when then President Lyndon B Johnson signed the Medicare program into law on July 30, 1965. Ever since then, Medicare beneficiaries upon entitlement, have been issued a Health Insurance Claim Number (HICN). The primary issuer of the HICN is the social security administration with the railroad retirement Board issuing HIC numbers for railroad workers. Beginning in 2018 the Medicare HIC number will be replaced with a new identifier called a Medicare Beneficiary Identifier (MBI). The MBI numbers will be…
VIEW POSTHome Health PEPPER is HOT!
By Melinda Gaboury / Posted on: May 26, 2017 5 minutes to readOne of the Hot Topics surrounding the medical review contractors and Medicare MACs is Home Health PEPPER (Program for Evaluating Payment Patterns Electronic Report)! Pepper is an accumulation and calculation of certain statistics that result from claims data. These Medicare claims data statistics are calculated for areas that may be at risk for improper Medicare payments such as…
VIEW POSTHow To Access The Provider Statistical & Reimbursement Report
By Aaron Carey / Posted on: March 17, 2017 3 minutes to readIt is that time of year again. Cost report season for home health and hospice providers. Cost reports are due five months after your agency fiscal year end. For agencies with a 12/31/16 fiscal year end cost reports are due by 05/31/17.
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HIPAA for Home Care | Establishing A Compliant Agency
By Drew Rowley / Posted on: March 3, 2017 5 minutes to readHIPAA has become an acronym synonymous with healthcare. We see it practiced and preached daily throughout the home care and hospice industry. However, too often breach notifications are at the top of our industry headlines. These breaches are costing our agencies time, money, and patient credibility. If we as agency owners, administrators, and employees understand the severity of a breach then why are breaches still occurring?
VIEW POSTAre You Thriving?
By Melinda Gaboury / Posted on: January 20, 2017 4 minutes to readThe constant additions of new programs and new methods, updates and consideration of changes is almost unbearable for some agencies. Home Health has been hit really hard since 2008 and no relief seems to be coming. Value-Based Purchasing, Pre-Claim Review, New CoPs, OASIS-C2, ICD-10 CM and now possibly major changes to the Prospective Payment System in regard to reimbursement.
VIEW POSTAre you G Code Savvy?
By Melinda Gaboury / Posted on: January 13, 2017 6 minutes to readMany have not yet realized that there were additional G codes introduced that went into effect January 1, 2017. These codes were not a part of the 2017 Home Health Final Rule, but were introduced in the CR9736 issued November 10, 2016.
VIEW POSTLate NOE Exceptions Clarified
By Melinda Gaboury / Posted on: January 4, 2017 6 minutes to readNotices of Election (NOE) that are filed and/or accepted at the Medicare Administrative Contractor (MAC) outside of the required 5 calendar day requirement, penalizes the hospice and the hospice does not receive reimbursement for any services until the NOE is accepted at the MAC. There have been some significant reimbursement issues with hospices due to this requirement, even when the issue was out of the control of the hospice and due to a Medicare system processing issue.
VIEW POSTSearch Home Health in the NEAR Future!
By Melinda Gaboury / Posted on: December 21, 2016 5 minutes to read…
VIEW POSTNO OASIS Submission Equals NO Payment
By Aaron Carey / Posted on: November 15, 2016 5 minutes to read…
VIEW POST2017 FINAL Home Health Rule
By Melinda Gaboury / Posted on: November 3, 2016 6 minutes to read…
VIEW POSTReimbursement Impact of OASIS-C2
By Melinda Gaboury / Posted on: October 7, 2016 3 minutes to read…
VIEW POSTBREAKING NEWS – PRE-CLAIM REVIEW DELAYED
By Melinda Gaboury / Posted on: September 20, 2016 3 minutes to read…
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Proposed VBP Changes 2017
By Liz Landreth / Posted on: July 20, 2016 10–12 minutes to read…
VIEW POST2017 Proposed Home Health Rule
By Melinda Gaboury / Posted on: July 13, 2016 4 minutes to read…
VIEW POSTA Bit of Relief with HbA1c Update!
By Liz Landreth / Posted on: May 10, 2016 3 minutes to read…
VIEW POSTCan You Afford to Ignore?
By Melinda Gaboury / Posted on: March 11, 2016 6 minutes to read…
VIEW POSTWill it Ever End? – Medicare Prior Authorization!
By Melinda Gaboury / Posted on: February 26, 2016 3 minutes to read…
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Medicaid and F2F: The Day has Officially Arrived!
By Dedra Briggs / Posted on: February 9, 2016 8 minutes to read…
VIEW POSTValue Based Purchasing: What We Weren’t Sure of!
By Melinda Gaboury / Posted on: January 14, 2016 4 minutes to read…
VIEW POST2016 HHRG Tables & Hospice CBSAs!
By Melinda Gaboury / Posted on: December 22, 2015 2 minutes to read…
VIEW POST2016 HHRG Tables & Hospice CBSAs!
By Melinda Gaboury / Posted on: December 22, 2015 2 minutes to read…
VIEW POSTUshering In 2016 – Kick off the Year Right!
By Melinda Gaboury / Posted on: December 11, 2015 5 minutes to read…
VIEW POST2016 Home Health Rates Continued Decline!
By Melinda Gaboury / Posted on: November 13, 2015 3 minutes to read…
VIEW POSTThe Nervous Nine Have Been Confirmed!
By Melinda Gaboury / Posted on: November 2, 2015 5 minutes to read…
VIEW POSTNew G-Codes Not JUST for HOSPICE!
By Melinda Gaboury / Posted on: October 23, 2015 5 minutes to read…
VIEW POSTThe Complexities of Medicare Secondary Payer Billing
By Aaron Carey / Posted on: October 16, 2015 6 minutes to read…
VIEW POSTFinally Some Relief or Not!
By Melinda Gaboury / Posted on: September 29, 2015 4 minutes to read…
VIEW POSTHome Care and Hospice: Still No Relief!
By Melinda Gaboury / Posted on: September 11, 2015 5 minutes to read…
VIEW POSTIs Canceling RAPs a Strategy for your Agency?
By Melinda Gaboury / Posted on: August 31, 2015 7 minutes to read…
VIEW POSTCMS Issues 2016 FINAL Hospice Rule – Part 2
By Melinda Gaboury / Posted on: August 21, 2015 5 minutes to read…
VIEW POSTAre You Overwhelmed by it All?
By Melinda Gaboury / Posted on: July 22, 2015 6 minutes to read…
VIEW POST2016 Proposed Rates Cannot Be Ignored!
By Melinda Gaboury / Posted on: July 15, 2015 5 minutes to read…
VIEW POSTMedicare Web Portals – Navigating the “Dark Days”
By Aaron Carey / Posted on: June 28, 2015 4 minutes to read…
VIEW POSTHome Care HIPPS Code Corrections When Re-Coded
By Melinda Gaboury / Posted on: May 27, 2015 5 minutes to read…
VIEW POSTMedicare Managed Care – Can it be Managed? (Part Three)
By Aaron Carey / Posted on: April 21, 2015 9 minutes to read…
VIEW POSTMedicare Managed Care – Can it be Managed? (Part Two)
By Aaron Carey / Posted on: April 15, 2015 8 minutes to read…
VIEW POSTMedicare Managed Care – Can it be Managed?
By Aaron Carey / Posted on: April 6, 2015 5 minutes to read…
VIEW POSTAdditional Development Request Checklist
By Dedra Briggs / Posted on: March 9, 2015 6 minutes to read…
VIEW POSTOASIS to Claim Data Matching
By Aaron Carey / Posted on: February 9, 2015 4 minutes to read…
VIEW POSTHome Care Final Rule 2015: Case-Mix & CBSA Changes!
By Melinda Gaboury / Posted on: January 12, 2015 5 minutes to read…
VIEW POSTHome Care Final Rule 2015: Case-Mix & CBSA Changes!
By Melinda Gaboury / Posted on: January 12, 2015 5 minutes to read…
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